Provider Demographics
NPI:1760029516
Name:LEONE, MATT ALAN
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:ALAN
Last Name:LEONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 N COLFAX RD APT 21
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1447
Mailing Address - Country:US
Mailing Address - Phone:360-201-5032
Mailing Address - Fax:
Practice Address - Street 1:1960 N HOLY NAMES CT FL 3
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-5803
Practice Address - Country:US
Practice Address - Phone:509-455-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program